Del Bono Valerio, Mikulska Małgorzata, Viscoli Claudio
Division of Infectious Diseases, San Martino University Hospital, University of Genova, Genova, Italy.
Curr Opin Hematol. 2008 Nov;15(6):586-93. doi: 10.1097/MOH.0b013e328311890c.
Invasive aspergillosis is a common cause of morbidity and mortality in hematopoietic stem cells transplant recipients. Owing to its intrinsic high mortality rate, early diagnosis and treatment are critical. This review will therefore address the most important recent advances in diagnosing, preventing and treating invasive aspergillosis in hematopoietic stem cells transplant.
The present review will focus on therapeutic and prophylactic aspects, with particular regard to clinical use of drugs other than voriconazole (which has a well known and consolidated role for first-line therapy), combination therapy and prophylactic regimens, particularly with posaconazole. This review will also briefly deal with the clinical role of diagnostic tests such as the detection of galactomannan in body fluids other than blood, beta-D-glucan in serum and fungal DNA by PCR in body fluids.
Galactomannan antigen detection is a rather reliable diagnostic test for invasive aspergillosis, particularly when a lower threshold of sensitivity is used. PCR is still to be validated. Liposomal amphotericin B at 3 mg/kg per day showed a similar efficacy in invasive aspergillosis as reported for voriconazole. Therapeutic drug monitoring of Aspergillus-active azoles should be implemented whenever possible in order to maximize the antifungal effect and minimize toxicity. Posaconazole showed to be active in prophylaxis, though its effectiveness in the global patient population is still controversial.
侵袭性曲霉病是造血干细胞移植受者发病和死亡的常见原因。由于其固有的高死亡率，早期诊断和治疗至关重要。因此，本综述将阐述造血干细胞移植中侵袭性曲霉病诊断、预防和治疗方面的最重要最新进展。
本综述将重点关注治疗和预防方面，尤其关注伏立康唑（其在一线治疗中具有众所周知且已确立的作用）以外药物的临床应用、联合治疗和预防方案，特别是泊沙康唑。本综述还将简要探讨诊断检测的临床作用，如在血液以外的体液中检测半乳甘露聚糖、血清中的β - D - 葡聚糖以及通过聚合酶链反应检测体液中的真菌DNA。
半乳甘露聚糖抗原检测是侵袭性曲霉病相当可靠的诊断检测，尤其是当使用较低敏感性阈值时。聚合酶链反应仍有待验证。每天3毫克/千克的脂质体两性霉素B在侵袭性曲霉病中的疗效与伏立康唑报道的相似。只要有可能，就应实施针对曲霉活性唑类药物的治疗药物监测，以最大化抗真菌效果并最小化毒性。泊沙康唑在预防方面显示有活性，尽管其在全球患者群体中的有效性仍存在争议。
